Music as a therapeutic intervention on an inpatient neuroscience unit.

The purpose of this study was to determine the effect of a music intervention (MI) on physiological parameters, pain and mood states in the neuroscience patient. This study enrolled and randomized subjects to 1 of 2 groups, usual care (UC) group (n=29) or UC plus MI (n=24). Data collected were physiologic parameters, pain and mood states pre and post a 30 min MI with UC compared to UC. The sample was 16 males/37 females, mean age of 55.8 years, with similar baseline characteristics. There were significant reductions in heart rate (t=-2.1, p<0.04), respirations (t=-3.4, p<0.001), perceived anxiety (t=-4.1, p<0.000), depression (t=-4.3, p<0.000), and total mood score (t=-4.1, p<0.000) in subjects who received UC plus MI compared to UC. The inclusion of MI as a therapeutic intervention for neuroscience patients appears to decrease the emotional burden of hospitalization.

The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes.

Clinical nurse specialists (CNSs) are vital members of the healthcare delivery leadership team. The knowledge and expertise of the CNS is germane to the quality of care a patient receives. More than 50 CNSs practice at Massachusetts General Hospital (the state's first Magnet hospital), where they share their clinical skills, mentor staff through difficult situations, identify learning needs, and implement innovative approaches to patient care. This article presents a brief history of the CNS role and describes how the CNS role is operationalized at Massachusetts General Hospital and its impact on unit-based and organizational outcomes. In addition, several programs and interventions identified by the CNSs in response to results of the Staff Perception of the Professional Practice Environment Survey are discussed. How the CNS influences the professional development of staff and potential implications for the future role of the CNS are described. An exemplar is included depicting a typical work day of a CNS on an acute adult medical unit.

Complexities in decision making for persons with disabilities nearing end of life.

Good end-of-life care requires that clinicians, families, and ethicists be aware of biases that influence patient cases, particularly in the acute care setting where the aim is primarily cure and return to optimal functional level. Persons with disabilities may pose unique challenges; their potential for quality of life is viewed through the lens of highly functional clinicians who might have a biased view of the disabled person's quality of life. The authors aim to present three categories of disability that do not claim to be absolute but rather offer clinicians and ethicists a lens through which to reflect on bias that unconsciously may influence their approach to the patient who is seriously ill and may be nearing the end of life. The categories include (a) a person who has lived with a disability from birth or early life, due to trauma or disease, and is now faced with a serious illness that requires that life-sustaining treatment; (b) the otherwise healthy person who acquires a disability through an acute event of disease or trauma and whose condition requires that life-sustaining treatment decisions be made; and (c) the person who has lived with a progressive chronic illness, such as lung or heart disease or amyotrophic lateral sclerosis, and may have gradually adjusted to disabilities imposed by the condition and now is faced with life-sustaining treatment decisions. The concept of inherent dignity (Pellegrino 2005) is suggested as a filtering lens in case consideration.